Emergency Department Case-finding for High-risk Older Adults: The Brief Risk Identification for Geriatric Health Tool (BRIGHT)
Michal Boyd RN, ND, NP
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorJane Koziol-McLain PhD, RN
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorKim Yates MBChB, MMedSc
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorNgaire Kerse MBChB, PhD, FRNZCGP
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorChris McLean Dip.Ind.Rels, Dip Counselling
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorCarole Pilcher RN, BHSc
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorGillian Robb MPH
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorMichal Boyd RN, ND, NP
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorJane Koziol-McLain PhD, RN
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorKim Yates MBChB, MMedSc
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorNgaire Kerse MBChB, PhD, FRNZCGP
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorChris McLean Dip.Ind.Rels, Dip Counselling
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorCarole Pilcher RN, BHSc
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorGillian Robb MPH
From the Divisions of Home and Older Adult Services (MB), Emergency Medicine (KY), Waitemata District Health Board (CM, CP), North Shore City; the Department of Nursing, Auckland University of Technology, and the Department of General Practice & Primary Health Care (NK), Departments of Epidemiology & Biostatistics, School of Population Health (GR), University of Auckland, Auckland, New Zealand.
Search for more papers by this authorPresented at the Society for Academic Emergency Medicine Annual Meeting, Chicago, IL, May 16–19, 2007.
Funding was provided by the Waitemata District Health Board, University of Auckland, and an Auckland University of Technology research grant (to MB).
Abstract
Objective: The objective was to test the ability of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify older emergency department (ED) patients with functional and physical impairment.
Methods: This was a cross-sectional study in which 139 persons ≥75 years, who presented to an urban New Zealand ED over a 12-week period, completed the 11-item BRIGHT case-finding tool. Then, within 10 days of their index ED visit, 114 persons completed a comprehensive geriatric assessment. A “yes” response to at least 3 of the 11 BRIGHT items was considered “positive.” Primary outcome measures were instrumental activities of daily living (IADL), cognitive performance scale (CPS), and activities of daily living (ADL).
Results: The BRIGHT-identified IADL deficit (64% prevalence) with a sensitivity of 0.76, specificity of 0.79, and receiver operating characteristic (ROC) of 0.83 (95% confidence interval [CI] = 0.74 to 0.91, p < 0.01); cognitive deficit (35% prevalence) sensitivity of 0.78, specificity of 0.54, and ROC of 0.66 (95% CI = 0.55 to 0.76, p = 0.006); and ADL deficit (29% prevalence) sensitivity of 0.83, specificity of 0.53, and ROC of 0.64 (95% CI = 0.53 to 0.75, p = 0.020). Positive likelihood ratios (LR+) for the three outcomes of interest were 3.6, 1.7, and 1.8, respectively. Negative likelihood ratios (LR−) were 0.3, 0.4, and 0.3.
Conclusions: The 11-item BRIGHT successfully identifies older adults in the ED with decreased function and may be useful in differentiating elder patients in need of comprehensive assessment.
ACADEMIC EMERGENCY MEDICINE 2008; 15:598–606 © 2008 by the Society for Academic Emergency Medicine
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